Friday, January 6, 2017

For health care though, 2017 is looking more and more like
it will be a year of turning back.
Assuming, that is, that the GOP-controlled Congress and incoming Trump
administration are able to enact their plan to repeal, delay and replace the
Affordable Care Act.

Full repeal of the ACA will mean turning back to a time when
millions more people were uninsured, and when insurance companies routinely
denied coverage or limited benefits to people who were sick.

It would mean going back to the days when more than 20
percent of Americans were uninsured because they did not qualify for Medicaid
and other safety-net programs, and couldn’t afford private insurance, compared
to fewer than 10 percent who are without insurance today.

It would mean going back to the days when women were charged
higher premiums than men for no other reason than that they were women.

It would mean going back to a time when insurers were not
required to offer coverage for preventive services, contraception, maternity
care, mental health, and many other essential benefits, and if they did offer
them, they were often subject to deductibles and co-payments.

It would mean going back to the days when insurance
companies were allowed to impose annual and lifetime dollar caps on benefits,
which often meant bankruptcy for people with expensive conditions like cancer.

The GOP has already started the process of repealing the
ACA, scheduling a vote next week on a budget resolution that instructs congressional
committees to come up with legislation to repeal as much of the ACA as they can
through a process called budget reconciliation, which can be passed by a simple
majority vote, no Democrats needed. The budget resolution would put Congress on
the path to repealing the ACA in stages, an approach that has been called
“repeal, delay and replace.” (The New
York Times has a
good primer on how repeal, delay and replace would play out
legislatively).

While the GOP argues that “repeal, replace and delay” will
allow people to keep their current coverage while Congress comes up with a “better”
replacement, it isn’t likely to work out that way. More likely, millions will begin losing
coverage as early as later this year, as I argued in my
recent Annals commentary, something that even many well-respected
conservatives
are starting to acknowledge.

Still, the GOP congressional leadership seems committed to rolling
back the ACA in stages, disregarding the fact that that only 20
percent of the public supports repeal,
delay and replace, the warnings
about the chaos it will introduce into insurance markets, and the
near-impossibility that the GOP will be able to (eventually) craft a
replacement that will cover as many as the ACA, with comparable benefits and
consumer protections, that can also win Democratic votes. This
means that at some point, most likely starting a few months from now, and
certainly by the time when delayed ACA repeal would actually take place in 2018
or 2019, we will go back to the bad old days, before the ACA became law in
2010, when millions more people were uninsured, and when insurance companies
routinely denied coverage or limited benefits to people who were sick.

It doesn’t have to be
this way, though. ACP is doing
everything we can to persuade Congress not to move forward with ACA repeal,
delay and replace; all it takes is 3 Republican Senators to say no repeal
especially without being offered a viable replacement for consideration. Here are some of the things we are doing:

ACP joined with the American Academy of
Pediatrics, American Academy of Family Physicians, American College of
Obstetrics and Gynecology, in
a letter urging the Senate to vote no on a resolution that would start the
process of repealing the ACA.Collectively, our organizations represent nearly 400,000 physician and
medical student members.

ACP has developed advocacy resources to help
make the case against repeal, delay and replace, including my
December 15 blog post on “There must be 50 ways you can lose your health
insurance (if Obamacare is repealed);a fact
sheet on the impact of repeal;a table
showing the impact in each state on the number of uninsured, people with
pre-existing conditions, and uncompensated care costs;and an at-a-glance
profile of the impact for each state.

We sent an
urgent alert to the 19,000 ACP members who have volunteered to be an
Advocate for Internal Medicine, asking them to call their Senators to urge a no
vote on the repeal resolution.

Next week, we will be communicating with
Congress about the key questions that should be asked of any proposals to
amend, improve, or replace the ACA, to ensure that patients are not
harmed.The letter will be posted on ACP
Online on Monday.

ACP has been using social media to draw
attention to our concerns about repeal, delay and replace; you can follow me on
Twitter at @bobdohertyACP, the
Advocates for Internal Medicine network at @AdvocatesIM, and the ACP Public
Affairs department @ACPInternists.

The encouraging news is that our concerns are being widely
reported by the press and not just through social media, including an opinion
piece by New York Times columnist
Nicolas Kristof, the Los
AngelesTimes
(same story also published in The Chicago
Tribune, San Diego Union-Tribune, Orlando
Sentinel, Baltimore Sun and Charlotte
Observer), Forbes,
Politico,
Washington
Examiner, and the Providence
Journal.

But ACP won’t be successful in stemming the drive to repeal
the ACA unless thousands of physicians raise their voices directly with members
of Congress. The Senate is expected to
vote on the resolution to start ACA repeal next Wednesday, January 18. We need
every doctor who does not want to see nearly 60
million people lose coverage to call your Senators, 202-224-3121, between
today and Wednesday to urge them to vote against repeal.

If you don’t act, Congress may very well take us back to the
pre-ACA days, when millions more were uninsured and insurers routinely denied
coverage or limited benefits for sick people.
We must not let that happen.

Today’s question:
have you called your Senators to urge them to vote against ACA repeal?